VOLUNTEER REGISTRATION FORM

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Camp CHOICE Youth Right to Life Summit- October 13th-15th, 2023 in East St. Louis, IL

Email *

Date: *

YYYY

Volunteer Name: *

Phone: *

Age: *

Gender: *

Female

Male

Other:

Ethnicity/Race: *

T Shirt Size: *

XXL

Other:

Food Allergies/Restrictions: *

Relevant Medical Conditions: *

For emergency medical treatment my preferred hospital is: *

Medical Insurance Carrier: *

Medical Card ID #: *

Consent for Treatment:

I hereby give my consent to be treated by emergency medical personnel, a physician, or surgeon, in case of sudden illness or injury while participating in the above activity. It is understood that Camp CHOICE will provide no medical insurance for such treatment, and that the cost thereof will be at my expense.

Volunteer Digital Signature: *

A copy of your responses will be emailed to the address you provided.

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